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1.
Enferm. clín. (Ed. impr.) ; 30(2): 89-98, mar.-abr. 2020. tab
Artigo em Espanhol | IBECS-Express | ID: ibc-FGT-3071

RESUMO

Objetivo: Diseñar y validar un procedimiento enfermero de cribado de la neuropatía periférica diabética en atención primaria. Método: El estudio se llevó a cabo en tres fases. 1) Construcción de un banco de ítems para conformar el procedimiento con una puntuación de salida que describiera la situación clínica del paciente. 2) Prueba y reducción del procedimiento tentativo inicial sobre una muestra de 50 pacientes usuarios de consultas enfermeras comunitarias, eliminando los componentes con baja fiabilidad inter-intra enfermeras. 3) Validación de la versión del procedimiento obtenida en el paso anterior sobre una muestra de 106 pacientes. Cálculo de validez y fiabilidad eliminando componentes con baja validez de criterio respecto a los resultados de la electromiografía diagnóstica utilizada como patrón de referencia. Se estimaron puntos de corte para el empleo del procedimiento como herramienta de cribado, valores predictivos, rendimiento, consistencia interna y fiabilidad inter-intra enfermera. Resultados: El procedimiento tentativo inicial constó de 12 componentes que fueron reducidos a 10. En el proceso de validación de esta segunda versión el procedimiento se simplificó nuevamente, quedando conformado por 6 componentes, con un punto de corte de 2,5 en su escala de salida, punto en el que alcanza valores adecuados de sensibilidad y predictivos negativos para emplearlo como instrumento de cribado. Para este punto de corte la fiabilidad inter-intra enfermeras, la validez de criterio y la validez predictiva alcanzaron valores aceptables. Conclusiones: NeuDiaCan como procedimiento de cribado enfermero de la neuropatía periférica diabética en atención primaria resulta válido, fiable y de fácil empleo


Objective: To design and validate a nursing screening procedure for diabetic peripheral neuropathy in primary care. Methods: The study was carried out in three phases. 1) Construction of an item bank to form the procedure with an exit score describing the patient's clinical situation. 2) Test and reduction of the initial tentative procedure on a sample of 50 patients using community nurse consultations, eliminating the components with low inter-intra nurse reliability. 3) Validation of the version of the procedure obtained in the previous step on a sample of 106 patients. Calculation of validity and reliability by eliminating components with low criterion validity with respect to the results of the diagnostic electromyography used as a reference standard. Cut-off points were estimated for the use of the procedure as a screening tool, predictive values, performance, internal consistency and inter-nurse reliability. Results: The initial tentative procedure consisted of 12 components that were reduced to 10. In the process of validation of this second version the procedure was simplified again, eventually comprising 6 components, with a cut-off point of 2.5 in its output scale, the point at which it reaches adequate values of sensitivity and negative predictors to be used as a screening instrument. For this cut-off point the inter-intra nurse reliability, criterion validity and predictive validity reached acceptable values. Conclusions: NeuDiaCan as a nursing screening procedure for diabetic peripheral neuropathy in primary care is valid, reliable and easy to use

2.
Artigo em Inglês | MEDLINE | ID: mdl-31752212

RESUMO

Saturation in hospital emergency departments is one of the main safety problems for the patient, which can generate negative consequences for their health. In response to this issue, triage systems are developed to organize the flow of patients in order to allow the most urgent ones to be treated first. The Emergency Severity Index (ESI) is the most used triage system in the USA and it has been implemented in the General Hospital of La Palma since 2010. The objective of this study is the validation of the ESI adapted to our hospital through the study of its degree of reliability, as well as the criterion validity. The sample consisted of 240 randomly selected cases, with proportional representation of emergencies attended in 2015 and their fraction of urgent ones (Levels 1 and 2). Criterion validity was estimated by sensitivity, specificity, and predictive result values. For reliability, the degree of agreement among the nurses was studied by means of the adapted kappa index kc2. Criterion validity showed a sensitivity of 89% (85-93%) and a specificity of 97% (94-99%), with a positive predictive value of 68% (62-74%) and a negative predictive value of 99% (98-100%) for the discrimination of urgent cases. The reliability analysis showed a kc2 = 0.94 (0.84-0.99) index, a very good agreement according to Landis-Koch criteria. The results of our study have shown adequate validity and reliability in the adaptation and implementation of an ESI triage system suited to the specific conditions of a hospital emergency service in Spain.

3.
Enferm Clin ; 2019 Sep 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31515153

RESUMO

OBJECTIVE: To design and validate a nursing screening procedure for diabetic peripheral neuropathy in primary care. METHODS: The study was carried out in three phases. 1)Construction of an item bank to form the procedure with an exit score describing the patient's clinical situation. 2)Test and reduction of the initial tentative procedure on a sample of 50 patients using community nurse consultations, eliminating the components with low inter-intra nurse reliability. 3)Validation of the version of the procedure obtained in the previous step on a sample of 106 patients. Calculation of validity and reliability by eliminating components with low criterion validity with respect to the results of the diagnostic electromyography used as a reference standard. Cut-off points were estimated for the use of the procedure as a screening tool, predictive values, performance, internal consistency and inter-nurse reliability. RESULTS: The initial tentative procedure consisted of 12 components that were reduced to 10. In the process of validation of this second version the procedure was simplified again, eventually comprising 6 components, with a cut-off point of 2.5 in its output scale, the point at which it reaches adequate values of sensitivity and negative predictors to be used as a screening instrument. For this cut-off point the inter-intra nurse reliability, criterion validity and predictive validity reached acceptable values. CONCLUSIONS: NeuDiaCan as a nursing screening procedure for diabetic peripheral neuropathy in primary care is valid, reliable and easy to use.

4.
Acta Vet Hung ; 67(3): 317-326, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31549546

RESUMO

The aim of this study was to determine the prevalence of methicillin-resistant Staphylococcus (MRS) in healthy goats on the Island of Tenerife, Spain, as well as to identify the phenotypic and genotypic characteristics of the strains found. A cross-sectional prevalence study was conducted. A total of 158 goats from 15 different farms were sampled between September 2017 and January 2018. The percentage of positive samples of methicillin-resistant Staphylococcus aureus (MRSA) was 15.8% (25/158) and that of methicillin-resistant coagulase-negative staphylococci (MRCoNS) was 6.9% (11/158). All MRSA isolates from goats belonged to one clonal group showing Multi-Locus Sequence type 398. All strains studied (n = 36) were resistant to non-carbapenem beta-lactam antibiotics and susceptible to teicoplanin, linezolid, vancomycin, rifampicin, quinupristin-dalfospristin and mupirocine. In MRSA isolates, the highest percentage of resistance obtained, besides beta-lactam non-carbapenem antibiotics, was to trimethoprim-sulphamethoxazole and, in the case of MRCoNS isolates, to phosphomycin and erythromycin. A total of 12 resistance patterns were obtained, presenting differences between patterns obtained for MRSA and MRCoNS, with 7 different patterns for MRSA and 5 for MRCoNS. We therefore consider it essential to expand the epidemiological study of these strains of animal origin, as well as to increase surveillance and control measures at all stages of the food chain.

5.
World J Orthop ; 10(6): 235-246, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31259147

RESUMO

BACKGROUND: Idiopathic clubfoot is a congenital deformity of multifactorial etiology. The initial treatment is eminently conservative; one of the methods applied is the Functional physiotherapy method (FPM), which includes different approaches: Robert Debré (RD) and Saint-Vincent-de-Paul (SVP) among them. This method is based on manipulations of the foot, bandages, splints and exercises adapted to the motor development of the child aimed to achieve a plantigrade and functional foot. Our hypothesis was that the SVP method could be more efficient than the RD method in correcting deformities, and would decrease the rate of surgeries. AIM: To compare the RD and SVP methods, specifically regarding the improvement accomplished and the frequency of surgery needed to achieve a plantigrade foot. METHODS: Retrospective study of 71 idiopathic clubfeet of 46 children born between February 2004 and January 2012, who were evaluated and classified in our hospital according to severity by the Dimeglio-Bensahel scale. We included moderate, severe and very severe feet. Thirty-four feet were treated with the RD method and 37 feet with the SVP method. The outcomes at a minimum of two years were considered as very good (by physiotherapy), good (by percutaneous heel-cord tenotomy), fair (by limited surgery), and poor (by complete surgery). RESULTS: Complete release was not required in any case; limited posterior release was done in 23 cases (74%) with the RD method and 9 (25%) with the SVP method (P < 0.001). The percutaneous heel-cord tenotomy was done in 2 feet treated with the RD method (7%) and 6 feet (17%) treated with the SVP method (P < 0.001). Six feet in the RD group (19%) and twenty-one feet (58%) in the SVP group did not require any surgery (P < 0.001). CONCLUSION: Our study provides evidence of the superiority of the SVP method over the RD method, as a variation of the FPM, for the treatment of idiopathic clubfoot.

6.
Aten Primaria ; 2019 Jul 01.
Artigo em Espanhol | MEDLINE | ID: mdl-31272849

RESUMO

OBJECTIVE: To determine the status of tobacco consumption in the Canary Islands during 2000-2015, according to social class. LOCATION: Canary Islands. PARTICIPANTS: General population cohort, with contacts in 2000 (n=6,729), 2008 (n=6,171) and 2015 (n=4,705). MAIN MEASUREMENTS: Smoking, gender, age, and social class. RESULTS: Consumption decreased by 6% (5-7%, P<.001) in general, being more accentuated in the period 2000-2008 (5%). The decrease was greater in men, although they continued to smoke more than women, with a prevalence of 25% (24-26%) compared to 18% (17-19%, P<.001). A decrease in consumption was only observed in the younger groups (6% [3-5%], P=.011) and intermediate ages (7% [6-8%], P<.001). A similar decrease was observed in all the social classes, but there was a higher prevalence of smoking in the upper class: 24% (23-25%) in 2015 (P<.001). By jointly assessing gender, age, and social class, younger and middle age men had the greatest decreases in consumption: 8% (7-9%) low and upper classes, 10% (9-11%) middle class. In the lower social class, younger women continue to smoke more (27%) although more of them quit smoking (14%), a phenomenon that occurred in the middle class at intermediate ages. CONCLUSIONS: The evolution of tobacco consumption in the Canary Islands follows a pattern similar to that of mainland Spain. The abandonment of tobacco consumption has slowed down in the period 2008-2015, especially in men, and middle and upper social classes.

7.
Rev. esp. enferm. dig ; 111(7): 507-513, jul. 2019. tab
Artigo em Espanhol | IBECS-Express | ID: ibc-ET1-4831

RESUMO

Introducción: estudio prospectivo y aleatorizado para valorar la influencia de la sedación consciente, con midazolam y fentanilo, sobre la calidad global de la colonoscopia, cuantificando simultáneamente su efecto sobre la calidad científica, la calidad percibida y la seguridad del paciente. Método: se incluyeron prospectivamente pacientes remitidos para colonoscopia y se aleatorizaron para recibir o no sedación. Se recogieron datos demográficos, indicación de la colonoscopia, intubación cecal, grado de limpieza colónica, tiempo de introducción y retirada, adenomas resecados y complicaciones durante la exploración y recuperación del paciente. Treinta días después se realizó un cuestionario de satisfacción (GHAA 9-me) y se preguntó por las complicaciones tras la exploración. Resultados: se incluyeron 5.328 pacientes (edad 62 +/- 15,22; 47% varones; 3.734 sedados y 1.594 sin sedación). Los pacientes sedados mostraron menor tiempo de introducción del endoscopio (7'20 +/- 2'15 vs. 6'15 +/- 3'12 minutos; p < 0,019), mayor tasa de intubaciones del ciego (96% vs. 88%; p < 0,05), tiempo de retirada más prolongado (7'20 +/- 2'15 vs. 6'15 +/- 3'12 minutos; p < 0,01) y mayor tasa de adenomas (22% vs. 17; p < 0,05), adenomas avanzados (8% vs. 4,3%; p < 0,05) y pólipos serrados (1,9% vs. 0,6%; p = 0,05). El uso de sedación disminuyó las molestias durante y después de la exploración, sin aumentar las complicaciones. La puntuación del cuestionario de satisfacción fue mayor (23,6 +/- 1,5 vs. 16,6 +/- 4,8; p < 0,001) en los pacientes sedados. Conclusiones: la sedación superficial con midazolam y fentanilo no solo disminuye las molestias de los pacientes, sino que mejora la calidad global de la colonoscopia. Por esto, debemos considerar el uso de sedación como una parte imprescindible de la colonoscopia


Introduction: a prospective, randomized study was performed to assess the influence of conscious sedation on the overall quality of colonoscopy, simultaneously quantifying its effect on the scientific quality, perceived quality and patient safety. Methods: patients referred for a colonoscopy were included in the study and were randomized to receive or not receive sedation. Demographic data, indication for colonoscopy, cecal intubation, introduction and withdrawal time, resected adenomas and complications during the exploration were collected. Thirty days later, a satisfaction questionnaire was performed (GHAA 9-me) and patients were asked about complications after the examination. Results: a total of 5,328 patients were included, the average age was 62 +/- 15.22 years, 47% were male, 3,734 were sedated and 1,594 were not sedated. The sedated patients had a shorter endoscope insertion time (7'20 +/- 2'15 min vs 6'15 +/- 3'12 min, p < 0.019), a higher rate of cecal intubations (96% vs 88%, p < 0.05), longer withdrawal time (7'20 +/- 2'15 min vs 6'15 +/- 3'12 min, p < 0.01) and higher adenoma detection rates (22% vs 17%, p < 0.05). The use of sedation reduced discomfort during and after the exploration, without increasing the complications. The satisfaction questionnaire score was higher (23.6 +/- 1.5 vs 16.6 +/- 4.8, p < 0.001) in the sedated patients. Conclusions: superficial sedation not only reduces patient discomfort but also improves the overall quality of the colonoscopy. Therefore, we must consider the use of sedation as an essential part of colonoscopy

8.
Artigo em Inglês | MEDLINE | ID: mdl-31146341

RESUMO

The objective of the present study is to assess the model's impact on patients and their families in terms of outcomes and the efficiency results for the health system in Tenerife, Canary Islands, selecting a period of eight years from the time interval 2002-2018. The employed indicators were collected on a monthly basis. They referred to home care and its impact on clinical outcomes and on the use of resources. The comparison between the indicators' tendencies with and without the liaison nurse model was done with the F-test by Snedecor. All these tests are bilateral, with a level of significance of p < 0.05. In those areas with community liaison nurse (CLN), improvements have been found in indicators that describe: (1) the management of the clinical status of patients, (2) the efficiency of the use of resources, and (3) the quality and compliance with the process that also includes home visits and social risk detection and management. It can be said that in the basic areas of primary health care where the work of the CLN develops there are improvements in the management of the patients' clinical condition as well as in the quality and efficiency of care.


Assuntos
Administração de Caso , Serviços de Assistência Domiciliar/organização & administração , Enfermeiras e Enfermeiros , Feminino , Humanos , Avaliação de Resultados da Assistência ao Paciente , Atenção Primária à Saúde/organização & administração , Espanha
9.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 54(3): 129-135, mayo-jun. 2019. tab, graf
Artigo em Espanhol | IBECS-Express | ID: ibc-FGT-2912

RESUMO

Introducción: El envejecimiento poblacional requiere que los sistemas sanitarios y sociales centren su atención en la identificación de la fragilidad en los ancianos. En Canarias, no existen estudios que determinen la prevalencia de fragilidad en su población. El objetivo del presente estudio es determinar la prevalencia y perfil de fragilidad en la isla de La Palma (Islas Canarias, España). Material y método: Estudio transversal para estimar la prevalencia y el perfil de la fragilidad. La muestra estuvo formada por residentes mayores de 70 años, valorados mediante los criterios de Fried, considerando otros factores relacionados. La prevalencia se ofrece en intervalo de confianza al 95% y se compara con la de otras poblaciones españolas. Para determinar el perfil se realizaron comparaciones simples de las variables, usadas posteriormente en modelos de regresión logística. Todas las pruebas fueron bilaterales a un nivel p ≤ 0,05. Resultados: La prevalencia de fragilidad en personas mayores de 70 años se estimó en un 20% (17-23%). Esta prevalencia muestra diferencias con las de otras poblaciones españolas. Los factores que mostraron asociación con la fragilidad fueron el ser mujer, estar viudo, vivir solo, baja actividad física, deterioro cognitivo, depresión, polimedicación y antecedentes clínicos adversos. El análisis multivariable identifica como asociadas a la fragilidad variables relacionadas con el estado civil, la convivencia, la polifarmacia, los estados depresivos y la falta de ejercicio físico. Conclusiones: Los ancianos de La Palma presentan mayor fragilidad en comparación con la descrita en otras regiones de España; su perfil es el de una persona viuda, con depresión, polimedicada, que vive sola y no realiza ejercicio


Introduction: Population ageing requires that health and social systems focus their attention on identifying frailty in the elderly. In the Canary Islands, there are no studies to determine the prevalence of frailty among its population. The objective of this study is to determine the prevalence and profile of frailty in the island of La Palma, Canary Islands, Spain. Material and method: A cross-sectional study was conducted to estimate the prevalence and the profile of frailty. The sample were residents over 70 years old, valued by the Fried criteria, and taking into account other related factors. The prevalence is offered with a confidence interval of 95% and is compared with that of other Spanish populations. To determine the profile, a simple comparison of variables was made, followed by using them in logistic regression models. All the tests were bilateral at a P≤0.05 level. Results: The prevalence of frailty in people over 70 years was estimated at 20% (17-23%). This prevalence shows differences with those of other Spanish populations. The factors that showed a relationship with frailty were, being female, widowed, living alone, low physical activity, cognitive impairment, depression, polymedication, and adverse clinical history. Multivariate analysis identifies factors associated with the frailty variables related to marital status, co-existence, polypharmacy, depressive states, and lack of physical exercise. Conclusions: The elderly population of La Palma have greater frailty compared to that described in other regions of Spain, with their profile being that of a widowed person, with depression, polymedicated, living alone, and not exercising

10.
Rev Esp Enferm Dig ; 111(7): 507-513, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31117800

RESUMO

INTRODUCTION: a prospective, randomized study was performed to assess the influence of conscious sedation on the overall quality of colonoscopy, simultaneously quantifying its effect on the scientific quality, perceived quality and patient safety. METHODS: patients referred for a colonoscopy were included in the study and were randomized to receive or not receive sedation. Demographic data, indication for colonoscopy, cecal intubation, introduction and withdrawal time, resected adenomas and complications during the exploration were collected. Thirty days later, a satisfaction questionnaire was performed (GHAA 9-me) and patients were asked about complications after the examination. RESULTS: a total of 5,328 patients were included, the average age was 62 ± 15.22 years, 47% were male, 3,734 were sedated and 1,594 were not sedated. The sedated patients had a shorter endoscope insertion time (7'20 ± 2'15 min vs 6'15 ± 3'12 min, p < 0.019), a higher rate of cecal intubations (96% vs 88%, p < 0.05), longer withdrawal time (7'20 ± 2'15 min vs 6'15 ± 3'12 min, p < 0.01) and higher adenoma detection rates (22% vs 17%, p < 0.05). The use of sedation reduced discomfort during and after the exploration, without increasing the complications. The satisfaction questionnaire score was higher (23.6 ± 1.5 vs 16.6 ± 4.8, p < 0.001) in the sedated patients. CONCLUSIONS: superficial sedation not only reduces patient discomfort but also improves the overall quality of the colonoscopy. Therefore, we must consider the use of sedation as an essential part of colonoscopy.

11.
Vet Sci ; 6(2)2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30987334

RESUMO

The problem of emerging resistant microorganisms such as Methicillin-Resistant Staphylococcus aureus (MRSA) associated to livestock is closely linked to improper use of antimicrobial agents. The aim of this study is to find out the prevalence and characteristics of these strains, as well as their evolution in healthy pigs on the Island of Tenerife, Spain. Between October 2009 and December 2010, 300 pigs from 15 wean-to-finishing farms were screened. Between 1 September 2017 and 31 March 2018, a new sampling was performed collecting 125 nasal swabs from pigs belonging to the same farms and under the same conditions as the previous study. MRSA antibiotic resistant patterns were studied. Results: Prevalence of MRSA isolates was 89.6%. All isolates belonged to Sequence Type 398 (ST398), a livestock related strain. All strains studied were resistant to beta-lactamic non-carbapenemic antibiotics and sensitive to teicoplanin, linezolid, vancomycin, rifampicin, quinupristin-dalfospristin, and mupirocine. Between 2009/2010-2017/2018 a significant increase in resistance to gentamicin, tobramycin, trimethoprim-sulfomethoxazole, clindamycin, Fosfomycin, and tigecycline antibiotics was observed in isolated MRSA strains compared to the previous period. We consider a major control and surveillance program of antibiotic use in veterinary care is needed in order to reduce the presence of MRSA strains in livestock and control this significant multi-resistance increase.

12.
Rev Esp Geriatr Gerontol ; 54(3): 129-135, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-30777385

RESUMO

INTRODUCTION: Population ageing requires that health and social systems focus their attention on identifying frailty in the elderly. In the Canary Islands, there are no studies to determine the prevalence of frailty among its population. The objective of this study is to determine the prevalence and profile of frailty in the island of La Palma, Canary Islands, Spain. MATERIAL AND METHOD: A cross-sectional study was conducted to estimate the prevalence and the profile of frailty. The sample were residents over 70 years old, valued by the Fried criteria, and taking into account other related factors. The prevalence is offered with a confidence interval of 95% and is compared with that of other Spanish populations. To determine the profile, a simple comparison of variables was made, followed by using them in logistic regression models. All the tests were bilateral at a P≤0.05 level. RESULTS: The prevalence of frailty in people over 70 years was estimated at 20% (17-23%). This prevalence shows differences with those of other Spanish populations. The factors that showed a relationship with frailty were, being female, widowed, living alone, low physical activity, cognitive impairment, depression, polymedication, and adverse clinical history. Multivariate analysis identifies factors associated with the frailty variables related to marital status, co-existence, polypharmacy, depressive states, and lack of physical exercise. CONCLUSIONS: The elderly population of La Palma have greater frailty compared to that described in other regions of Spain, with their profile being that of a widowed person, with depression, polymedicated, living alone, and not exercising.

13.
Farm. hosp ; 43(1): 13-18, ene.-feb. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182581

RESUMO

Objetivo: Evaluación del impacto clínico y económico tras el cambio de protocolo de uso de basiliximab en el trasplante ortohepático. Método: Estudio retrospectivo en el que se incluyó a todos los pacientes trasplantados de hígado durante los años 2013, 2014 y hasta el 15 de febrero de 2015. El estudio se dividió en dos etapas según el protocolo empleado: 1) administración de basiliximab solo si existían factores de riesgo previos, y 2) administración de la primera dosis de basiliximab a todos los pacientes trasplantados y de una segunda dosis si existían factores de riesgo. Resultados: Se incluyeron 83 pacientes, 34 según el protocolo 1 y 49 según el protocolo 2. No se encontraron diferencias significativas en las variables clínicas evaluadas ni en las variables relacionadas con los resultados en salud. Considerando que el porcentaje de pacientes sin factores de riesgo que recibieron basiliximab fue del 43% y sin diferencias en las estancias, podríamos estimar un coste adicional por el empleo universal de basiliximab en el trasplante ortohepático de 21.400 Euros. Conclusiones: En nuestra población, el cambio de protocolo haciendo universal la primera dosis de basiliximab no ha mostrado los beneficios esperados, pero sí un aumento de los costes, por lo que debe replantearse la idoneidad del nuevo protocolo en consenso con el equipo médico. La evidencia en relación con el empleo de basiliximab en el trasplante ortohepático sigue siendo limitada y aunque parece claro su beneficio en pacientes con factores de riesgo, especialmente fallo renal, las recomendaciones acerca de su uso de forma universal sigue siendo controvertido


Objective: Evaluation of the clinical and economic impact after the protocol change of basiliximab use in orthohepatic transplant. Method: Retrospective study in which all liver transplant patients were included during the years 2013, 2014 and until February 15, 2015. The study was divided into two stages according to the protocol used: 1) administration of basiliximab only if factors of previous risk, and 2) administration of the first dose of basiliximab to all transplant patients and the second dose if it had risk factors. Results: 83 patients were included, 34 according to protocol 1 and 49 according to protocol 2. No significant differences were found in the clinical variables evaluated or in the variables related to health outcomes. Considering that the percentage of patients without risk factors who received basiliximab was 43% and without differences in the stays, we could estimate an additional cost for the universal use of basiliximab in orthohepatic transplant of Euros 21,400.00. Conclusions: In our population, the protocol change making universal the first dose of basiliximab has not shown the expected benefits, but an increase in costs, so the suitability of the new protocol in consensus with the medical team must be reconsidered. The evidence regarding the use of basiliximab in orthohepatic transplant remains limited and although its benefit seems clear in patients with risk factors, especially renal failure, recommendations about its use universally remains controversial


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Basiliximab/economia , Basiliximab/uso terapêutico , Imunossupressores/economia , Imunossupressores/uso terapêutico , Complicações Pós-Operatórias/economia , Basiliximab/efeitos adversos , Protocolos Clínicos , Cuidados Críticos/economia , Imunossupressores/efeitos adversos , Testes de Função Renal , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
14.
Farm Hosp ; 43(1): 13-18, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30624168

RESUMO

OBJECTIVE: Evaluation of the clinical and economic impact after the protocol  change of basiliximab use in orthohepatic transplant. METHOD: Retrospective study in which all liver transplant patients were included  during the years 2013, 2014 and until February 15, 2015. The study was divided into two stages according to the protocol used: 1) administration of basiliximab  only if factors of previous risk, and 2) administration of the first dose of  basiliximab to all transplant patients and the second dose if it had risk factors. RESULTS: 83 patients were included, 34 according to protocol 1 and 49 according  to protocol 2. No significant differences were found in the clinical  variables evaluated or in the variables related to health outcomes. Considering  that the percentage of patients without risk factors who received basiliximab was 43% and without differences in the stays, we could estimate an additional cost  for the universal use of basiliximab in orthohepatic transplant of € 21,400.00. CONCLUSIONS: In our population, the protocol change making universal the first  dose of basiliximab has not shown the expected benefits, but an increase in  costs, so the suitability of the new protocol in consensus with the medical team  must be reconsidered. The evidence regarding the use of basiliximab in  orthohepatic transplant remains limited and although its benefit seems clear in  patients with risk factors, especially renal failure, recommendations about its use universally remains controversial.


Assuntos
Basiliximab/economia , Basiliximab/uso terapêutico , Imunossupressores/economia , Imunossupressores/uso terapêutico , Transplante de Fígado/economia , Transplante de Fígado/métodos , Basiliximab/efeitos adversos , Protocolos Clínicos , Cuidados Críticos/economia , Feminino , Humanos , Imunossupressores/efeitos adversos , Testes de Função Renal , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
15.
J Infect Public Health ; 12(1): 37-42, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30266540

RESUMO

OBJECTIVE: Secondary bacteraemia infections (SBI) are poorly studied. We analyse the epidemiology of nosocomial SBI, potential risk factors and mortality of affected patients. METHODS: Prospective study of patients with bacteraemia from 2009 to 2014 in a tertiary hospital. For each SBI was recorded: primary source of infection, aetiological agent, demographic data, intrinsic and extrinsic risk factors and mortality during the episode. RESULTS: 429/1918 episodes of Nosocomial Bacteraemia (NB) (22%) were SBI (average Incidence Density: 0.41% days of admission). Onco-hematological services had the highest Incidence Density of SBI. Surgical Site Infection-SBI (SSI-BSI) was the most frequent SBI (27%), followed by Urinary Tract Infection-SBI (UTI-BSI) (24%). Gram-negative bacteria were the most prevalent microorganism (61.1%). The median interval between SBI episodes to discharge was 37±59days. Mortality rate was 29%. These patients had many intrinsic and extrinsic risk factors such as urinary catheterization (68%), CVC (69%), Arterial hypertension (48%) and hospitalization in the six previous months (45%). Mean age was significantly higher in patients with UTI-BSI and SSI-BSI. Average stay from admission to the development of bacteraemia was statistically lower in patients with Intra-abdominal Infection bacteraemia (IAB-BSI). Patient with SSI-BSI had oncologic processes and had undergone for more Mechanical ventilation than UTI-SSBI and Respiratory Tract Infections Bacteraemia (RTI-BSI). The use of CVC was significantly higher in RTI-BSI. CONCLUSIONS: SBI accounts for almost a quarter of all NB. Patients has multiple comorbidities, increases hospital stay and mortality. It would be necessary to establish measures to rapidly diagnose and treat the primary infection, in order to prevent the onset of SBI.


Assuntos
Bacteriemia/epidemiologia , Coinfecção/sangue , Coinfecção/epidemiologia , Infecção Hospitalar/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/mortalidade , Coinfecção/microbiologia , Coinfecção/mortalidade , Infecção Hospitalar/sangue , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Feminino , Bactérias Gram-Negativas , Infecções por Bactérias Gram-Negativas/sangue , Infecções por Bactérias Gram-Negativas/epidemiologia , Hospitalização , Hospitais Universitários , Humanos , Hipertensão/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Mortalidade , Prevalência , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Centros de Atenção Terciária , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/epidemiologia
16.
Matronas prof ; 20(1): 30-38, 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183286

RESUMO

Objetivo: Diseñar y validar un cuestionario para valorar el riesgo de embarazo adolescente no planificado (EANP). Método: Diseño de un cuestionario para valorar el riesgo de EANP a partir de todos los factores relacionados descritos en la literatura. Se validó posteriormente sobre una muestra de adolescentes de La Palma clasificadas como EANP y no EANP con estimación de fiabilidad por test-retest. Resultados: El cuestionario partía de 36 ítems. Con la finalidad de validar la apariencia y el contenido de este cuestionario inicial, se constituyó un grupo de expertos y otro de adolescentes con EANP. La muestra de validación la conformaron 148 adolescentes, con una media de edad ± desviación estándar de 21 ± 2 años, entre las que figuraba un 36% de EANP. Se eliminaron 27 ítems por no tener relación con el EANP. Su coeficiente alfa de Cronbach alcanzó un valor de 0,78 con la eliminación de un ítem redundante, por lo que el cuestionario final quedó conformado por 8 ítems. La validez de constructo mediante análisis factorial confirmatorio ratificó la estructura de 5 dimensiones, con un 76% de variabilidad de respuestas explicada. Se establecieron reglas cualitativas de afectación de ítems, dimensiones y de salida global del cuestionario. La validez de criterio mostró una sensibilidad de 0,87 (intervalo de confianza [IC] del 95%: 0,81-0,93) y un valor predictivo de resultado negativo de 0,86 (IC del 95%: 0,80-0,92). La fiabilidad presentó un índice kappa de 0,77 (IC del 95%: 0,70-0,84). Todos estos parámetros alcanzaron un valor de p <0,001. Conclusión: Las propiedades métricas del cuestionario obtenido (Instrumento de valoración del Riesgo de Embarazo No Esperado [IRENE]), junto con su facilidad y rapidez de administración, lo convierten en un medio adecuado de cribado para detectar a una adolescente en situación de riesgo de embarazo no planificado y valorar sobre qué aspectos podemos incidir para intentar reducirlo


Objective: Design and validate a questionnaire to assess the risk of unplanned adolescent pregnancy (UAP). Method: The design of a questionnaire to assess the risk of UAP from all the related factors described in the literature. It is subsequently validated on a sample of adolescents from La Palma classified as UAP and not UAP with reliability estimation by test-retest. Results: The questionnaire starts from 36 items. An expert group and another group of teenagers with UAP carry out their validity of appearance and content. The validation sample is made up of 148 adolescents aged 21 ± 2 years with 36% of UAP. 27 items are eliminated because they are not related to the UAP. The Cronbach alpha reaches 0.78 with an elimination of a redundant item, the final questionnaire was formed by 8 items. The construct validity by confirmatory factor analysis confirms the 5-dimensional structure with 76% variability of responses explained. Qualitative rules of affectation of items, dimensions and global exit of the questionnaire are established. The criterion validity shows 0.87 (95% CI: 0.81-0.93) of sensitivity and 0.86 (95% CI: 0.80-0.92) of predictive value of negative result. Reliability presents a kappa index of 0.77 (95% CI: 0.70-0.84). All these parameters achieve p <0.001. Conclusion: The metric properties of the questionnaire obtained (Unexpected Pregnancy Risk Assessment Instrument [IRENE]), together with its ease and speed of administration, make it an adequate means of screening to detect a teenager at risk of unplanned pregnancy and assess what aspects we can influence to try to reduce it


Assuntos
Humanos , Feminino , Gravidez , Adolescente , Gravidez na Adolescência/prevenção & controle , Gravidez na Adolescência/estatística & dados numéricos , Medição de Risco/métodos , Gravidez não Desejada , Indicadores Básicos de Saúde , Inquéritos e Questionários , Intervalos de Confiança , Espanha , Análise de Dados
17.
Enferm. clín. (Ed. impr.) ; 28(4): 240-246, jul.-ago. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-182241

RESUMO

La atención de enfermería ante un caso de duelo es compleja. En el tratamiento del duelo, poco se sabe sobre el plan de cuidados planificado por las enfermeras de Atención Primaria. Objetivo: Conocer los criterios de resultado e intervenciones planificadas por las enfermeras para los dolientes con y sin complicaciones en la comunidad autónoma de Canarias. Método: Estudio retrospectivo transversal, realizado con los registros de la historia clínica informatizada de Atención Primaria del Servicio Canario de la Salud en aquellos pacientes diagnosticados de duelo, riesgo de duelo complicado y duelo complicado en el periodo 2009-2014. Resultados: Se registran criterios de resultado NOC en el 67% de los dolientes, identificando hasta 24 diferentes. Los principales en la atención del doliente con complicaciones son: Resolución de la aflicción; Modificación psicosocial, cambio de vida; Afrontamiento de problemas; Afrontamiento de los problemas de la familia; Clima social de la familia y Salud emocional del cuidador principal. El resto está presente en menos del 1% de los dolientes. Pese a que los criterios de resultado que proponen las enfermeras en los dolientes con y sin complicaciones son bastante homogéneos, se encuentran diferencias en las intervenciones. Se registran intervenciones NIC en el 67%. Se identifican 99 intervenciones diferentes en los dolientes, siendo las más frecuentes en aquellos en los que registró alguna intervención: Apoyo emocional; Facilitar el duelo; Escucha activa; Aumentar el afrontamiento y Asesoramiento. El resto de intervenciones identificadas está presente en menos del 5% de los pacientes. Se realizan más en los dolientes con complicaciones: Facilitar el duelo; Aumentar el afrontamiento; Escucha activa; Asesoramiento y Estimulación de la integridad familiar. Conclusión: Los registros enfermeros demuestran que hay más intervenciones y resultados planificados en dolientes con complicaciones. Dados los pocos estudios metodológicamente confiables que prueban su efectividad, se recomienda continuar la investigación en esta área


Nursing care in bereavement is complex. Primary health care is the ideal setting to support the bereaved, but we do not know much about the care plans designed by primary health care nurses in the treatment of grief. Objective: To identify the outcomes criteria and interventions planned by nurses for mourners with and without complications in the Canary Islands. Method: Retrospective longitudinal study, using the electronic health records of the Canary Islands health service of people with a diagnosis of grieving, risk of complicated grieving and complicated grieving, in the period 2009-2014. Results: NOC outcomes criteria were recorded in 67% of the mourners, and up to 24 different outcomes were identified. The main outcomes measures were Grief resolution; Psychosocial adjustment, Life change; Coping; Family coping; Family social climate and Caregiver emotional health. The remaining outcomes were present in less than 1% of the mourners. Although the outcomes criteria proposed by nurses in the mourners with and without complications were quite homogeneous, differences in interventions were found. In 67% of the cases, NIC interventions were reported. Ninety-nine different interventions were identified in the mourners; the most frequent were Emotional support; Grief work facilitation; Active listening; Coping enhancement and counselling. The remaining identified interventions were present in less than 5% of patients. The main interventions in the mourners with complications were Grief work facilitation; Coping enhancement; Active listening; Counselling and Family integrity promotion. Conclusion: Nurses state that there are more interventions and outcomes in mourners with complications. Given the few methodologically reliable studies that prove their effectiveness, continued research in this area is recommended


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/métodos , Enfermagem em Saúde Comunitária/organização & administração , Atenção Primária à Saúde , Espanha , Estudos Retrospectivos , Estudos Transversais , Enfermeiras e Enfermeiros/organização & administração
18.
Am J Public Health ; 108(8): 1091-1098, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29995474

RESUMO

OBJECTIVES: To analyze mortality in Spain and the United States before and after these countries implemented divergent policies in response to the financial crisis of 2008. METHODS: We examined mortality statistics in both countries in the years 2000 to 2015. Spain started austerity policies in 2010. We compared differences in mortality ratios, on the basis of trends and effect size analysis. RESULTS: During 2000 to 2010, overall mortality rates (r = 0.98; P < .001; Cohen's d = -0.228) decreased in both countries. In 2011, this trend changed abruptly in Spain, where observed mortality surpassed expected mortality by 29% in 2011 and by 41% in 2015. By contrast, observed mortality surpassed expected mortality in the United States by only 8% in 2015. As the mortality statistics diverged, the effect size greatly increased (d = 7.531). During this 5-year period, there were 505 559 more deaths in Spain than the expected number, while in the United States the difference was 431 501 more deaths despite the 7-fold larger population in the United States compared with Spain. CONCLUSIONS: The marked excess mortality in 2011 to 2015 in Spain is attributable to austerity policies.

19.
Respir Med ; 138: 123-128, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29724383

RESUMO

BACKGROUND: Cross-sectional and longitudinal studies describe shorter telomeres in patients with chronic obstructive pulmonary disease (COPD) compared to matched non-COPD controls, but the relationship is confounded by tobacco consumption. We hypothesized that telomere shortening would be similar between non-smoking and smoking individuals with airflow limitation and shorter than non-obstructed controls. METHODS: Telomere length (T/S) was measured by qPCR in blood leukocytes of 80 non-smoking patients and 80 age-matched smokers with airflow limitation. Forty non-smoker healthy individuals served as controls. Anthropometrics, lung function, previous and current comorbidities were recorded in all individuals. Relationship between telomere length and clinical and functional variables were explored in the three groups. RESULTS: Telomeres length was similar in non-smokers and smoker individuals with airflow limitation (T/S = 0.61 ±â€¯0.19 vs. 0.60 ±â€¯0.23, p > 0.05) respectively. Telomere length was significantly shorter in both groups compared to healthy controls (T/S 0.79 ±â€¯0.40; p = 0.01) independent from age and sex. No significant association was found between the telomere length and clinical or lung function parameters. CONCLUSIONS: Telomere shortening is associated with airflow limitation independent of smoking status. Weather premature ageing or biologically determined shorter telomeres are responsible for this finding remain to be determined.


Assuntos
Doença Pulmonar Obstrutiva Crônica/genética , Encurtamento do Telômero , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fumar/genética , Fumar/fisiopatologia , Capacidade Vital/fisiologia
20.
Enferm Clin ; 2018 Feb 19.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29472159

RESUMO

Nursing care in bereavement is complex. Primary health care is the ideal setting to support the bereaved, but we do not know much about the care plans designed by primary health care nurses in the treatment of grief. OBJECTIVE: To identify the outcomes criteria and interventions planned by nurses for mourners with and without complications in the Canary Islands. METHOD: Retrospective longitudinal study, using the electronic health records of the Canary Islands health service of people with a diagnosis of grieving, risk of complicated grieving and complicated grieving, in the period 2009-2014. RESULTS: NOC outcomes criteria were recorded in 67% of the mourners, and up to 24 different outcomes were identified. The main outcomes measures were Grief resolution; Psychosocial adjustment, Life change; Coping; Family coping; Family social climate and Caregiver emotional health. The remaining outcomes were present in less than 1% of the mourners. Although the outcomes criteria proposed by nurses in the mourners with and without complications were quite homogeneous, differences in interventions were found. In 67% of the cases, NIC interventions were reported. Ninety-nine different interventions were identified in the mourners; the most frequent were Emotional support; Grief work facilitation; Active listening; Coping enhancement and counselling. The remaining identified interventions were present in less than 5% of patients. The main interventions in the mourners with complications were Grief work facilitation; Coping enhancement; Active listening; Counselling and Family integrity promotion. CONCLUSION: Nurses state that there are more interventions and outcomes in mourners with complications. Given the few methodologically reliable studies that prove their effectiveness, continued research in this area is recommended.

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